Compounded compositions and methods for treating pain

ABSTRACT

A compounded capsule may include cannabidiol powder for combining with a solution, cream, gel, suspension or ointment for administration to a skin surface. The compounded capsule may also include xylitol powder.

CROSS-REFERENCE TO RELATED APPLICATIONS

This patent application is a continuation of U.S. patent application Ser. No. 16/867,057, filed May 5, 2020, now U.S. Pat. No. 10,966,946, which is a continuation-in-part of U.S. patent application Ser. No. 16/735,174, filed Jan. 6, 2020, now U.S. Pat. No. 11,278,508, which is a continuation of U.S. patent application Ser. No. 16/381,967, filed Apr. 11, 2019, now U.S. Pat. No. 10,525,025, which is a continuation-in-part of U.S. patent application Ser. No. 16/010,731, filed Jun. 18, 2018, now U.S. Pat. No. 10,610,503, which is a divisional of U.S. patent application Ser. No. 15/354,630 filed Nov. 17, 2016, now U.S. Pat. No. 9,999,604. The disclosures of U.S. patent application Ser. No. 16/735,174, U.S. patent application Ser. No. 16/381,967, U.S. patent application Ser. No. 16/010,731, and U.S. patent application Ser. No. 15/354,630 are hereby incorporated by reference herein.

TECHNICAL FIELD

The present application relates to compounded medications. In particular, the present application relates to topical compositions comprising cannabidiol, lidocaine, prilocaine, diclofenac, xylitol, and/or poloxamers and methods of making and using such topical compositions.

BACKGROUND

Pain is often treated with medication such as anti-inflammatory or local anesthetic drugs. Treatment can include administration of the medication via oral, intramuscular, subcutaneous, intravenous, and topical routes.

Cannabidiol (CBD) is a non-psychoactive cannabinoid agent found in cannabis species such as the hemp plant (Cannabis sativa L.) as well as other sources. It is an active ingredient in the FDA approved drug product EPIDIOLEX®, which is used to treat seizures. The FDA considers cannabidiol powder an API/drug, but it is not a controlled substance according to the DEA.

Diclofenac sodium topical solution is a non-steroidal anti-inflammatory drug (NSAID) indicated for the treatment of signs and symptoms of osteoarthritis of the knee. For the relief of such signs and symptoms, the recommended dose of diclofenac sodium topical solution, 1.5% (w/w), is 40 drops on each painful knee, 4 times a day.

Lidocaine hydrochloride topical solution is a local anesthetic agent indicated for the production of topical anesthesia of accessible mucous membranes of the oral and nasal cavities and proximal portions of the digestive tract. When used as a spray, or when applied by cotton applicators or packs, as when instilled into a cavity, the suggested dosage of Lidocaine Hydrochloride Topical Solution, 4%, is 1 to 5 mL (40 to 200 mg lidocaine HCl), i.e., 0.6 to 3 mg/kg or 0.3 to 1.5 mg/lb. body weight. When spraying, the solution is to be transferred from its original container to an atomizer.

Lidocaine and prilocaine cream, 2.5%/2.5% is a eutectic mixture of lidocaine 2.5% and prilocaine 2.5% formulated as an oil in water emulsion and is indicated for use on normal intact skin for local analgesia and genital mucous membranes for superficial minor surgery and as pretreatment for infiltration anesthesia. The cream is applied to intact skin under occlusive dressing to provide dermal analgesia by the release of lidocaine and prilocaine from the cream into the epidermal and dermal layers of the skin and by the accumulation of lidocaine and prilocaine in the vicinity of dermal pain receptors and nerve endings.

SUMMARY

In one aspect, a method of formulating a topical composition for administration to a skin surface may include combining cannabidiol powder and a cream including about 1.5% diclofenac sodium, about 2.5% lidocaine, and about 2.5% prilocaine.

In one example, combining the cannabidiol powder includes releasing the cannabidiol powder from a compounded capsule. In a further example, combining the cannabidiol powder with the cream includes combining between about 10 mg and about 50 mg of the cannabidiol powder with the cream.

In another aspect, a method of formulating a topical composition for administration to a skin surface includes combining between about 10 mg and about 50 mg cannabidiol powder, xylitol powder, and a solution, cream, gel, suspension, or ointment.

In one example, the method may include combining an NSAID, a local anesthetic, or combination thereof. The NSAID may include diclofenac and the local anesthetic includes lidocaine, prilocaine, or both.

In one example, the method may include combining diclofenac, lidocaine, and prilocaine. The diclofenac may be combined in an amount between about 0.5% and about 2% by weight of the topical composition, the lidocaine is combined in an amount between about 1.9% and about 3% by weight of the topical composition, and prilocaine is combined in an amount between about 1.9% and about 3% by weight of the topical composition.

In one example, at least a portion of the cannabidiol powder and xylitol powder are combined with the solution. The solution may include a diclofenac sodium, 1.5%, topical solution, lidocaine hydrochloride, 4%, topical solution, or both.

In one example, at least a portion of the cannabidiol powder and xylitol powder are combined with the cream. In one formulation at least a portion of the cream includes lidocaine and prilocaine, 2.5%/2.5%, cream.

In any of the above examples, the cannabidiol powder includes cannabidiol synthetic powder.

In one example, the cannabidiol powder is combined with the cream. The cream may include about 1.5% diclofenac sodium, about 2.5% lidocaine, and about 2.5% prilocaine. The cream may further include between 5% and 20% DMSO.

In still another aspect, a compounded capsule may include cannabidiol powder and xylitol powder. In one example, the compounded capsule may contain between about 10 mg and about 50 mg of the cannabidiol powder. The capsule may further include poloxamer powder. The poloxamer powder may include poloxamer 407 and poloxamer 188. In a further example, the compounded capsule may contain between about 10 mg and about 50 mg of the cannabidiol powder.

In yet another aspect, a method of providing pharmacological services includes dispensing one or more capsules containing between about 10 mg and about 50 mg cannabidiol powder and xylitol powder for combining with a solution, cream, gel, suspension, or ointment prior to administration of the combination to a skin surface.

In one example, the method may further includes dispensing the solution, cream, gel, suspension, or ointment.

DESCRIPTION

The present embodiments may relate to topically delivered or deliverable compositions including topical solutions, suspensions, creams, gels, and lotions of medications for treatment of various ailments, such as inflammation or pain. In various embodiments the topical composition may comprise compounded medications in a solution, suspension, cream, gel, ointment, or lotion format that may typically be topically administered at a body surface, such as a surface of skin.

In various embodiments, the topical composition may include at least one cannabinoid including cannabidiol and a one or more of a non-steroidal anti-inflammatory drug (NSAID), local anesthetic, steroid, antibacterial drug, antifungal drug, antiviral drug, anticonvulsant, or antidepressant. In one example, the topical composition comprises a cannabinoid comprising at least cannabidiol and at least two active agents including a local anesthetic and a NSAID. In one formulation, the local anesthetic comprises lidocaine, prilocaine, or both and the NSAID comprises diclofenac. In another formulation, the topical composition includes cannabidiol, lidocaine, and prilocaine and does not include a NSAID.

In one embodiment, the topical composition comprises cannabidiol and xylitol in a solution, cream, ointment, gel, or suspension. The topical composition may be applied to the skin. In one example, a capsule or kit including a capsule containing cannabidiol powder and xylitol or an xylitol containing filler and base solution, cream, ointment, gel, or suspension is provided for combining prior to administration. The capsule may include between about 5 mg and about 100 mg, such as between about 10 mg and about 50 mg cannabidiol, corresponding to a unit dosage for compounding with the base solution, cream, ointment, gel, or suspension. In one example, the capsule contains cannabidiol and LOXASPERSE® for combining with a solution, cream, ointment, gel, or suspension, and then applied to the skin. In another or a further example, the topical composition includes additional active agents, such as any described herein, such as local anesthetics, NSAIDS, analgesics, antidepressants, anticonvulsants, opioids, NMDA receptor antagonists, muscle relaxants, antifungals, antibiotics, antivirals, or combination thereof. The additional active agents may be combined in amounts between about 0.01% and 30% by weight individually and/or collectively. In one example, the additional active agents comprise diclofenac, lidocaine, and prilocaine in any amount or concentration described herein. In one embodiment, the contents of the capsule is combined with a cream containing about 1.5% diclofenac sodium, about 2.5% lidocaine, and about 2.5% prilocaine.

The topical composition may include all or some of the active agents in a powder and/or a commercially available medicated aqueous solution. In one formulation, the topical composition comprises a compounded formulation comprising cannabidiol and one or more commercially available medicated solutions comprising the NSAID and/or a local anesthetic and a commercially available medicated cream comprising one or more local anesthetic. For example, the topical composition may comprise a cannabidiol powder compounded with a NSAID solution and/or a commercially available local anesthetic solution compounded with a commercially available medicated cream comprising a local anesthetic. Such a topical composition may be stably formulated for topical delivery to treat various ailments, such as inflammation or pain. The compounded medications may include topical solutions, emulsions, ointments, creams, lotions, or gels that may be topically administered at a body surface within a solution, suspension, cream, gel, ointment, or lotion.

The topical composition may be formulated for effective administration of multiple incorporated medications simultaneously for treatment of one or more ailments may be provided. Ailments treated with the topical composition may include, for example, conditions such as inflammation, rheumatoid arthritis, osteoarthritis, lateral epicondylitis (tennis elbow), medial epicondylitis (golfer's elbow), chondromalacia patellae—CMP (runner's knee), tendonitis/carpel tunnel, soft tissue pain, fibromyalgia, diabetic neuropathy, peripheral neuropathy, neck pain, back pain, localized pain, plantar fasciitis, achilles tendonitis, tarsal tunnel—post-op massage, or heel pain. The topical composition may exhibit excellent storage characteristics, and avoid separation and/or degradation of the active ingredients in the aqueous environment for substantial lengths of time.

In some embodiments, the topical composition may include one or more cannabinoids and one or more local anesthetics and/or NSAIDs obtained from commercially available solutions, commercially available creams, bulk powders, ground tablets, or combination thereof of including such local anesthetics or NSAIDs. In one example, the one or more cannabinoids includes cannabidiol and less than 0.1%, such as less than 0.01%, tetrahydrocannabinol. In a further example, the cannabidiol is combined with the one or more local anesthetics and/or NSAIDs in a powder format. In a further example, the one or more local anesthetics comprise lidocaine and prilocaine and the one or more NSAIDs comprise diclofenac.

In various embodiments, the topical composition, which may include one or more additional active agents selected from one or more anticonvulsants, nerve depressants, muscle relaxants, NMDA (N-Methyl-D-aspartate) receptor antagonists, opiate or opioid agonists, antidepressants, and/or other active agents such as one or more steroids, antibacterial drugs, antifungal drugs, antiviral drugs, anticonvulsants, or antidepressants.

In various embodiments, the cannabinoid may be selected from cannabichromene (CBC), cannabichromevarin (CBCV), cannabidiol (CBD), cannabidiolic acid (CBDA), cannabidivarin (CBDV), cannabigerol (CBG), cannabigerovarin (CBCV), cannabigerol monomethyl ether (CBGM), cannabicyclol (CBL), cannabielsoin (CBE), cannabicitran (CBT), cannabinol (CBN), cannabivarin (CBV), tetrahydrocannabinol (THC), tetrahydrocannabinolic acid (THCA), tetrahydrocannabivarin (THCV), or combination thereof.

The cannabinoid may comprise cannabinoids within a whole plant extract or extract isolate, which may include one or more concentrated and/or substantially purified cannabinoids. In one embodiment, the cannabinoid comprises a synthetic cannabinoid analogue, homologue, or pharmaceutically acceptable salt, derivative, variant, or combination thereof. The amount of cannabinoid per gram of the topical composition may be between about 1 mg and about 100 mg. For example, per gram, the topical composition may comprise cannabidiol in an amount between about 2.5 mg and about 80 mg, about 2.5 mg and about 50 mg, about 2.5 mg and about 25 mg, about 2.5 mg and about 20 mg, about 2.5 mg and about 15 mg, about 2.5 mg and about 10 mg, about 5 mg and about 50 mg, about 5 mg and about 25 mg, about 5 g and about 15 mg, about 10 mg and about 50 mg, about 10 mg and about 25 mg, about 10 mg and about 15 mg, about 15 mg and about 80 mg, about 15 mg and about 50 mg, about 15 mg and about 25 mg, about 25 mg and about 80 mg, about 25 mg and about 50 mg, or less that about 50 mg, less than about 25 mg, less than about 20 mg, less than about 15 mg, less than about 10 mg, less than about 5 mg, or less than about 2.5 mg.

In one embodiment, the cannabinoid comprises a synthetic cannabidiol analogue, homologue, or pharmaceutically acceptable salt, derivative, variant, or combination thereof. In a further embodiment, the cannabidiol comprises a synthetic cannabidiol in a powdered format that is dissolved or suspended in solution, cream, gel, ointment, or lotion to formulate the topical composition. In one example, the cannabidiol comprises synthetic cannabidiol in a powder format having less than 1%, less than 0.5%, less than 0.1%, less than 0.05%, or less than 0.01% THC by weight.

As introduced above, the topical composition may include a cannabinoid and a NSAID. The NSAID may act to block the synthesis of prostaglandins by inhibiting cyclooxygenase-2 and cyclooxygenase-1, for example. In various embodiments, the NSAID agent may be selected from one or more salicylic acid derivatives (e.g., aspirin, diflunisal, salsalate, trilisate), one or more propionic acids (e.g., flurbiprofen, ibuprofen, ketoprofen, naproxen, oxaprozin), one or more acetic acids (e.g., diclofenac, etodolac, indomethacin, ketorolac, nabumetone, sulindac, tolmetin), one or more fenamates (e.g., meclofenamate), one or more oxicams (meloxicam, piroxicam), or one or more COX-2 inhibitors (e.g., celecoxib, rofecoxib, valdecoxib), or combinations thereof. For example, in one embodiment, the NSAID agent comprises a benzeneacetic acid derivative such as diclofenac or pharmaceutically acceptable salt thereof, which in one example is provided in an aqueous solution.

As introduced above, the topical composition may include a diclofenac topical solution comprising diclofenac in an aqueous solution. The diclofenac topical solution may be a commercially available diclofenac topical solution, such as diclofenac sodium solution for topical administration. The diclofenac sodium solution may contain, for example, 1.5% (w/w), diclofenac sodium wherein each 1 mL of solution contains about 16.05 mg of diclofenac sodium. In one embodiment, the diclofenac solution comprises a diclofenac sodium solution, 1.5% (w/w), such as that which is manufactured under the trade name PENNSAID® by Nuvo Manufacturing, Varennes, Quebec, Canada or Diclofenac Sodium Topical Solution, 1.5% (w/w), manufactured by Apotex Inc. Toronto, Ontario, Canada M9L 1T9 for Apotex Corp. Weston, Florida 33326 for treating the pain of osteoarthritis of the knee. The diclofenac solution may also contain various inactive ingredients such as dimethyl sulfoxide USP (DMSO, 45.5% w/w), ethanol, glycerin, propylene glycol and purified water. In one embodiment, the diclofenac solution comprises a diclofenac sodium solution marketed under the trade name PENNSAID® and manufactured by Nuvo Manufacturing, Varennes, Quebec, Canada, in a 2% (w/w) diclofenac solution for treating the pain of osteoarthritis of the knee. Each gram of solution may contain about 20 mg of diclofenac sodium and various inactive ingredients such as dimethyl sulfoxide USP (DMSO, 45.5% w/w), ethanol, purified water, propylene glycol, and hydroxypropyl cellulose. In other embodiments, other concentrations of diclofenac solution, such as diclofenac sodium solutions, may be used.

In various embodiments, the topical composition may comprise diclofenac sodium topical solution, 1.5% (w/w), in an amount between about 0.1 g and about 0.8 g per gram. For example, the topical composition may comprise between about 0.1 g and about 0.7 g, about 0.1 g and about 0.6 g, about 0.1 g and about 0.5 g, about 0.1 g and about 0.4 g, about 0.1 g and about 0.3 g, about 0.1 g and about 0.3 g, about 0.2 and about 0.8, about 0.2 g and about 0.7 g, about 0.2 g and about 0.6 g, about 0.2 g and about 0.5 g, about 0.2 g and about 0.4 g, about 0.2 and about 0.3 g, about 0.3 and about 0.8, about 0.3 g and about 0.7 g, about 0.3 g and about 0.6 g, about 0.3 g and about 0.5 g, about 0.3 g and about 0.4 g, about 0.4 and about 0.8, about 0.4 g and about 0.7 g, about 0.4 g and about 0.6 g, about 0.4 g and about 0.5 g, about 0.5 g and about 0.6 g, about 0.5 g and about 0.7 g, about 0.5 g and about 0.8 g, or greater than or equal to about 0.1 g, about 0.2 g, about 0.3 g, about 0.4 g, about 0.5 g, about 0.6 g, about 7 g, or about 0.8 g, or less than or equal to about 0.8 g, about 0.7 g, about 0.6 g, about 0.5 g, about 0.4 g, about 0.3 g, about 0.2 g, or about 0.1 g diclofenac sodium topical solution, 1.5% (w/w), per gram of topical composition. In one example, the topical composition comprises about 0.1 g, about 0.2 g, about 0.3 g, about 0.4 g, about 0.5 g, about 0.6 g, about 0.7 g, or about 0.8 g diclofenac sodium topical solution, 1.5% (w/w), per gram.

In various embodiments, the topical composition may include diclofenac bulk powder, such as diclofenac sodium or diclofenac potassium bulk powder. In a further or another example, the topical composition includes crushed diclofenac sodium tablets for oral administration containing diclofenac sodium. The tablets may also include one or more of aluminum hydrate, colloidal silicon dioxide, hypromellose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, polyethylene glycol, polysorbate 80, polyvinyl acetate phthalate, propylene glycol, silica, sodium alginate, sodium starch glycolate (Type A), stearic acid, synthetic black iron oxide, talc, or titanium dioxide. In a further or another example, the topical composition includes diclofenac sodium topical gel including diclofenac sodium. Diclofenac sodium topical gel may also contain one or more of carbomer homopolymer Type C, cocoyl caprylocaprate, fragrance, isopropyl alcohol, mineral oil, polyoxyl 20 cetostearyl ether, propylene glycol, purified water, or strong ammonia solution. Diclofenac sodium topical gel may be available as Diclofenac Sodium Topical Gel, 1% w/w. In an above or further example, the topical composition may include diclofenac potassium for oral solution containing diclofenac potassium and which is available as a flavored soluble powder that is designed to be mixed with water prior to oral administration. In an above or further example, the topical composition may include diclofenac potassium tablets for oral administration containing diclofenac potassium and which may also contain one or more of colloidal silicon dioxide, corn starch, FD&C Blue No. 2, FD&C Red No. 40, FD&C Yellow No. 6, hypromellose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, polyethylene glycol 4000, povidone, sodium starch glycolate, titanium dioxide, or tricalcium phosphate.

In some methods, diclofenac sodium topical solution, 1.5% (w/w), or equivalent is compounded in an amount between about 0.1 g and about 0.8 g per gram or in a lesser amount sufficient to provide between about 1.6 mg and about 20 mg of the diclofenac sodium present in one gram of the topical composition alone or together with one or more additional diclofenac sources, e.g. bulk powder or ground tablets. For example, diclofenac bulk powder, ground tablets, and/or diclofenac sodium topical solution, 1.5% (w/w), may be added in an amount sufficient to provide between 1.6 mg and about 20 mg, about 5 mg and about 16 mg, about 5 mg and about 15 mg, about 7 mg and about 15 mg, about 7 mg and about 10 mg, about 10 mg and about 20 mg, about 15 mg and about 20 mg, about 1.6 mg and about 12 mg, about 2 mg and about 10 mg, about 2 mg and about 9 mg, about 2 mg and about 8 mg, about 2 mg and about 7 mg, about 2 mg and about 6 mg, about 2 mg and about 5 mg, about 2 mg and about 4 mg, about 2 mg and about 3 mg, about 3 mg and about 9 mg, about 3 mg and about 8 mg, about 3 mg and about 7 mg, about 3 mg and about 6 mg, about 3 mg and about 5 mg, about 4 mg and about 12 mg, about 4 mg and about 11 mg, about 4 mg and about 10 mg, about 4 mg and about 9 mg, about 4 mg and about 8 mg, about 4 mg and about 7 mg, about 4 mg and about 6 mg, about 4 mg and about 5 mg, about 5 mg and about 12 mg, about 5 mg and about 11 mg, about 5 mg and about 10 mg, such as greater than or equal to about 1 mg, about 2 mg, about 4 mg, about 6 mg, about 8 mg, about 10 mg, about 12 mg, about 14 mg, about 16 mg, about 18 mg, or about 20 mg, or less than or equal to about 1 mg, about 2 mg, about 4 mg, about 6 mg, about 8 mg, about 10 mg, about 12 mg, about 14 mg, about 16 mg, about 18 mg, or about 20 mg or greater diclofenac or diclofenac sodium present in one gram of the topical composition.

The local anesthetic agent may comprise one or more local anesthetics selected from lidocaine, prilocaine, benzocaine, or combination thereof. All or a portion of the local anesthetic agent may be provided in a commercially available aqueous solution. Additionally or alternatively, all or a portion of the local anesthetic agent may be provided by a commercially available medicated cream (e.g., cream, hydrous ointment, gel, lotion, emulsion) or anhydrous ointment. In some of the above embodiments or another embodiment, the local anesthetic agent may include bulk powder, ground oral tablets, or both. For example, an NSAID topical solution may include a commercially available diclofenac, or pharmaceutically acceptable salt thereof, topical solution and a local anesthetic topical solution may include a commercially available lidocaine, or pharmaceutically acceptable salt thereof, topical solution. In embodiments including one or more additional NSAIDs, local anesthetics, or both, additional actives may be provided in commercially available solutions, creams, or bulk/pure powders or crushed commercial tablets and then combined with the topical composition or a component thereof. For example, one or more additional local anesthetic and/or NSAID actives may be provided in a solution, cream, ointment, bulk/pure powder, or crushed commercial tablet and then combined with the topical composition or a component thereof. The topical composition may also be supplemented with creams, bulk/pure powders, or crushed commercial tablets comprising an NSAID and/or local anesthetic that is also present in a commercial topical solution compounded to formulate the topical composition.

In various embodiments, the topical composition may include a lidocaine topical solution comprising lidocaine in an aqueous solution. The lidocaine topical solution may be a commercially available lidocaine topical solution, such as lidocaine hydrochloride solution for topical administration. The lidocaine hydrochloride solution may contain, for example, 4% lidocaine (w/v) wherein each mL includes 40 mg lidocaine HCl. For example, in one embodiment, the lidocaine topical solution may be Lidocaine Hydrochloride Topical Solution USP, 4% manufactured by IGI Labs, Inc., Buena, New Jersey, in 50 mL screw cap glass bottles. The lidocaine hydrochloride topical solution may contain various inactive ingredients such as methylparaben, purified water, and sodium hydroxide to adjust pH to 6.0-7.0.

In one embodiment, the topical composition includes lidocaine bulk powder, such as lidocaine hydrochloride USP monohydrate powder in addition to or instead of lidocaine topical solution. Lidocaine hydrochloride USP monohydrate powder includes 1 g of lidocaine per 1.23 g.

Prilocaine is another local anesthetic drug that may be compounded with the cannabinoid, e.g., cannabidiol, NSAID, and/or another local anesthetic to formulate the topical composition, which, in one example, may be compounded at least in part from one or more topical solutions such as diclofenac topical solution and/or lidocaine topical solution. Prilocaine may be compounded from prilocaine hydrochloride USP powder. Prilocaine hydrochloride USP powder includes 1 g of prilocaine per 1.165 g. In some embodiments, prilocaine may be compounded from Prilocaine Hydrochloride Injection, USP, 4%, which is a sterile, non-pyrogenic isotonic solution that contains prilocaine HCl 40 mg/mL at a pH of 6.0 to 7.0 and is designed to be administered parenterally by injection. In an above or another embodiment, prilocaine may be compounded from Prilocaine Hydrochloride 4% with epinephrine injection, which is a sterile, non-pyrogenic isotonic solution that contains prilocaine with epinephrine (as bitartrate) and is administered parenterally by injection. The injection solution is available as prilocaine epinephrine 1:200,000, containing prilocaine HCl 40.0 mg/mL, epinephrine 0.005 mg/mL, citric acid 0.2 mg/mL, and sodium metabisulfite 0.5 mg/mL and has a pH of 3.3 to 5.5.

The topical composition may be formulated by compounding one or more of the actives with a commercially available medicated composition, such as a solution, cream, or ointment, comprising two or more actives. For example, the topical composition may include a lidocaine and prilocaine cream. In one example, the topical composition includes Lidocaine 2.5% and Prilocaine 2.5% Cream, USP, (or Lidocaine and Prilocaine 2.5%/2.5% Cream) which is an emulsion in which the oil phase is a eutectic mixture of lidocaine and prilocaine in a ratio of 1:1 by weight. This eutectic mixture has a melting point below room temperature and therefore both local anesthetics exist as a liquid oil rather than as crystals. It is packaged in 5 gram and 30 gram tubes. Each gram of lidocaine and prilocaine cream contains lidocaine 25 mg, prilocaine 25 mg, polyoxyethylene fatty acid esters (as emulsifiers) such as PEG-60/hydrogenated castor oil, carboxypolymethylene (as a thickening agent) such as carbomer 934P, carbopol 5984, sodium hydroxide to adjust to a pH approximating 9, and purified water to 1 gram. Lidocaine 2.5% and Prilocaine 2.5% Cream, USP, is currently manufactured by Teligent Pharma, Inc., Buena, NJ 08310 USA, for distribution by Actavis Pharma, Inc., Parsippany, NJ 07054 USA. Lidocaine and prilocaine cream, 2.5%/2.5%, is also manufactured and distributed by other sources such as E. Fougera & Co. a division of Fougera Pharmaceuticals Inc., Melville, New York 11747.

In some embodiments, the topical composition includes a commercially available lidocaine and prilocaine periodontal gel, such as Periodontal Gel, 2.5%/2.5%, which is a microemulsion in which the oil phase is a eutectic mixture of lidocaine and prilocaine in a ratio of 1:1 by weight. This eutectic mixture has a melting point below room temperature; therefore, both local anesthetics exist as liquid oils rather than as crystals. Lidocaine and Prilocaine Gel 2.5%/2.5% is currently available under ORAQIX® (manufactured for Dentsply Pharmaceutical, York, PA 17404) in single-use glass cartridges that deliver up to 1.7 g (1.7 mL) of gel (42.5 mg of lidocaine and 42.5 mg of prilocaine). In various embodiments described herein including lidocaine and prilocaine cream, 2.5%/2.5%, lidocaine and prilocaine cream, 2.5%/2.5%, may be replaced in whole or in-part with Lidocaine and Prilocaine Gel 2.5%/2.5%.

In some embodiments, the topical composition comprises a topical solution portion comprising diclofenac sodium topical solution, 1.5% (w/w), and lidocaine hydrochloride topical solution, 4%. The topical composition may further comprise a lidocaine and prilocaine cream or gel, 2.5%/2.5% portion. The topical composition may also comprise a powder portion comprising cannabidiol, diclofenac, lidocaine, prilocaine, or combination thereof. The powder portion may comprise bulk powder or ground oral tablets. The powder portion may comprise pharmaceutically acceptable salts of the active agents, such as those identified herein. In some embodiments, the cannabidiol comprises a synthetic cannabidiol. The synthetic cannabidiol may be synthesized from D-limonene. The cannabidiol powder may comprise synthetic Cannabidiol (>98% Powder).

In one embodiment, the topical composition comprises a commercially available topical solution portion comprising a lidocaine hydrochloride solution and/or a diclofenac sodium solution and a lidocaine and prilocaine cream or gel, 2.5%/2.5% portion. For example, the topical composition may comprise a diclofenac sodium topical solution and lidocaine and prilocaine cream, 2.5%/2.5%. In another example, the topical composition comprises a commercially available diclofenac sodium solution, a commercially available lidocaine hydrochloride solution, and commercially available lidocaine and prilocaine cream, 2.5%/2.5%. In another or a further example, the topical composition comprises diclofenac sodium USP powder, lidocaine hydrochloride USP monohydrate powder, prilocaine hydrochloride USP powder, or combination thereof. The actives present in one or more bulk powders may also be replaced or supplemented with powder obtained from ground oral tablets comprising the actives. The bulk powder or ground oral tablets may comprise pharmaceutically acceptable salts of the active agents, such as those identified herein. The commercially available diclofenac sodium solution may be diclofenac sodium topical solution, 1.5% (w/w). The lidocaine hydrochloride solution may be lidocaine hydrochloride topical solution, 4%. The cannabidiol may comprise a synthetic cannabidiol powder. The synthetic cannabidiol may be synthesized from D-limonene and comprise synthetic Cannabidiol (>98% Powder).

In various embodiments, the topical composition formulated by combining a lidocaine hydrochloride topical solution, powder, cream, or ointment and diclofenac sodium topical solution or powder in relatively low concentrations of the active ingredients compared to conventional topical formulations including one or more of the active ingredients. Due to the formulation and combination described herein, the present topical composition may provide similar effectiveness while having an increased safety profile. The increased safety profile may be especially beneficial to patients with gastric bleeds, on blood thinners, etc. The provision of cannabidiol, e.g., synthetic powder, compounded with the lidocaine and diclofenac may address pain and/or inflammation. The compounded composition may also provide local anesthetic benefits while promoting deeper penetration into the skin and leveraging DMSO into the compounded topical cream, e.g., 45.5% (w/w) of the diclofenac sodium solution compounded with the lidocaine, such as lidocaine hydrochloride solution.

In various embodiments, the topical composition comprises a topical solution, suspension, cream, ointment, or gel including cannabidiol at a concentration between about 0.1% and about 25%, diclofenac or diclofenac sodium at a concentration between about 0.1% and about 1.9% and lidocaine or lidocaine hydrochloride at a concentration of between about 0.1% and about 4%. In a further example, the topical composition may include prilocaine at a concentration between about 0.1% and about 4%. In one example, the topical composition includes about 0.5% or more, about 2% or more, about 7% or more, about 10% of more, or about 17% or more cannabidiol, about 0.5% or more, about 1.0% or more, about 1.25% or more, or between about 1.1% and 3% diclofenac or diclofenac sodium, and about 1% or more, about 2% or more, about 3% or more, or about 4% or more lidocaine or lidocaine hydrochloride. In a further example, the topical composition may include prilocaine at a concentration between about 0.1% and about 4%, such as about 1% or more, about 2% or more, or about 3% or more. In one example, the topical composition comprises between about 2% and about 17% cannabidiol, between about 1.15% and about 1.6% diclofenac, and between about 1.9% and about 2.75% of each of lidocaine and prilocaine by weight. As used herein, the term about means+/−10% of the stated value it modifies. In some embodiments, the topical composition comprising a topical solution or suspension including between about 0.5% and about 20%, about 1.5% and about 17%, about 2.5% and about 17%, about 2% and about 20%, about 2% and about 17%, about 2% and about 15%, about 2% and about 10%, about 2% and about 7%, about 10% and about 20%, or about 10% and about 15%, cannabidiol by weight, between about 1.0% and about 2%, about 1.1% and about 1.8%, about 1.2% and about 1.7%, about 1.2% and about 1.6%, about 1.2% and about 1.5%, about 1.2% and about 1.4%, about 1.2% and about 1.3%, about 1.3% and about 1.6%, about 1.3% and about 1.5%, about 1.3% and about 1.4%, about 1.4% and about 1.6%, about 1.4% and about 1.5% diclofenac or diclofenac sodium, and between about 0.2% and about 0.8%, about 0.2% and about 0.7%, about 0.2% and about 0.6%, about 0.2% and about 0.5%, about 0.2% and about 0.4%, about 0.2% and about 0.3%, about 0.3% and about 0.7%, about 0.3% and about 0.6%, about 0.3% and about 0.5%, about 0.3% and about 0.4%, about 0.330% and about 0.340%, about 1.0% and about 4%, about 1% and about 3%, about 1% and about 2%, about 2% and about 4%, about 3% and about 4% lidocaine or lidocaine hydrochloride. In a further embodiment, the topical solution includes between about 0.2% and about 40%, about 1.0% and about 4%, about 1% and about 3%, about 1% and about 2%, about 2% and about 4%, or about 3% and about 4% prilocaine. For example, in various embodiments, the topical solution comprises between about 0.5% and about 10% cannabidiol, about 1.0% and about 2.0%, such as between about 1.3% and about 1.6%, diclofenac sodium, and between about 0.1% and about 0.5%, such as between about 0.3% and about 0.35%, lidocaine hydrochloride. In one embodiment, the topical solution includes between about 0.5% and about 20%, such as between about 2% and about 17% cannabidiol, between about 1.25% and about 1.47% diclofenac sodium, and between about 1.9% and about 2.45% of each of prilocaine or prilocaine hydrochloride and lidocaine or lidocaine hydrochloride. In another embodiment, the topical solution includes between about 2% and about 20% cannabidiol, about 1.5% diclofenac, about 2.5% lidocaine, and about 2.5% prilocaine by weight. In various embodiments, a method of formulating the topical composition includes combining between about 0.5% and about 20% cannabidiol synthetic powder, a commercially available diclofenac sodium solution, diclofenac sodium topical solution, 1.5% (w/w), or diclofenac sodium topical solution 2.0% (w/w) solution, and a commercially available lidocaine solution, such as lidocaine hydrochloride topical solution, 4%, to formulate the topical composition having one of the above listed concentrations or other concentration described herein of cannabidiol, diclofenac sodium, and lidocaine hydrochloride. In some embodiments, the topical composition comprises a topical solution as above with prilocaine at a concentration between about 1:2 and 2:1 of that of lidocaine. Stronger or weaker concentrations of diclofenac or diclofenac sodium topical solutions and lidocaine or lidocaine hydrochloride topical solutions may be used wherein the amounts of such solutions added are modified to achieve the appropriate concentrations. In some embodiments, the concentrations or amounts of diclofenac and lidocaine may be provided by compounding powders, crushed tablets, creams, ointments, gels, other formats in addition to or instead of diclofenac sodium solution and lidocaine hydrochloride solution.

In various embodiments, the topical composition comprises cannabidiol in any amount or concentration described herein and a commercially available diclofenac sodium topical solution, 1.5% (w/w), compounded with a commercially available lidocaine hydrochloride topical solution, 4%, wherein the topical composition includes diclofenac sodium topical solution, 1.5% (w/w), at a concentration between 0.1% and 99%, such as between 50% and 95%, (v/v) and lidocaine hydrochloride topical solution, 4%, at a concentration between 0.1% and 90%, such as 0.2% and 5%, (v/v). In one example, the topical composition includes about 80% or more, about 90% or more, or about 91.7% (v/v) diclofenac sodium topical solution, 1.5% (w/w), and about 4% or more, about 7% or more, or about 8.32% (v/v) lidocaine hydrochloride topical solution, 4%. In one embodiment, the topical composition includes about 90% (v/v) diclofenac sodium topical solution, 1.5% (w/w), and about 10% (v/v) lidocaine hydrochloride topical solution, 4%. In some embodiments, the topical composition includes between about 50% and about 98%, about 55% and about 97%, about 60% and about 96%, about 70% and about 95%, about 80% and about 95%, about 85% and about 95%, about 90% and about 95%, about 90% and about 94%, about 90% and about 93%, about 90% and about 92%, about 91% and about 93%, about 91% and about 92% (v/v) diclofenac sodium topical solution, 1.5% (w/w), and between about 2% and about 20%, about 4% and about 18%, about 6% and about 16%, about 6% and about 16%, about 6% and about 12%, about 6% and about 10%, about 7% and about 14%, about 7% and about 12%, about 7% and about 10%, about 8% and about 14%, about 8% and about 12%, about 8% and about 10% (v/v) lidocaine hydrochloride topical solution, 4%. For example, in various embodiments, the topical composition comprises between about 80% and about 95%, such as between about 90% and about 93% (v/v) diclofenac sodium topical solution, 1.5% (w/w), and between about 4% and about 14%, such as between about 7% and about 10% (v/v) lidocaine hydrochloride topical solution, 4%. In one embodiment, the topical composition includes about 91.7% diclofenac sodium topical solution and about 8.32% lidocaine hydrochloride topical solution, 4%. In various embodiments, a method of formulating the topical composition includes combining a commercially available diclofenac sodium solution, such as diclofenac sodium topical solution, 1.5% (w/w), with a commercially available lidocaine solution, such as lidocaine hydrochloride topical solution, 4%, to form a topical composition having one of the above listed concentrations (v/v) of diclofenac sodium topical solution, 1.5% (w/w), and lidocaine hydrochloride topical solution, 4%. In some embodiments, the topical composition comprises a topical solution as above further including prilocaine at a concentration between about 1:2 and 2:1 of that of lidocaine. Stronger or weaker concentrations of diclofenac or diclofenac sodium topical solutions and lidocaine or lidocaine hydrochloride topical solutions may be used wherein the amounts of such solutions added are modified to achieve the appropriate v/v concentrations.

In any embodiment described herein, the topical composition may include xylitol and/or poloxamer. Xylitol may be present in a weight percent between about 0.1% and about 5% or in another weight percent described above or elsewhere herein. Poloxamers may be present in a weight percent between about 0.1% and about 5% by weight. In one embodiment, the one or more poloxamers comprise poloxamer 407 and poloxamer 188. For example, a method of making the topical composition may include combining the contents of a capsule comprising cannabidiol powder and xylitol and/or poloxamer with a aqueous solution, cream, gel, ointment, lotion, or emulsion. The additional actives may be within the solution, cream, gel, ointment, lotion, or emulsion or may be combined with the same to formulate the topical composition.

In further or other embodiments, the method may also include combining cannabidiol in an amount described herein and one or more additional active agents comprising one or more NSAIDs selected from salicylic acid derivatives (e.g., aspirin, diflunisal, salsalate, trilisate), one or more propionic acids (e.g., flurbiprofen, ibuprofen, ketoprofen, naproxen, oxaprozin), one or more acetic acids (e.g., etodolac, indomethacin, ketorolac, nabumetone, sulindac, tolmetin), one or more fenamates (e.g., meclofenamate), one or more oxicams (meloxicam, piroxicam), or one or more COX-2 inhibitors (e.g., celecoxib, rofecoxib, valdecoxib), or combinations thereof, one or more local anesthetics selected from prilocaine, benzocaine, or combination thereof, one or more muscle relaxants selected from baclofen, carisoprodol, orphenadrine, cyclobenzaprine, dantrolene, tizanidine, amitriptyline, or combinations thereof, one or more NMDA receptor antagonists such as ketamine, or one or more opioid or opiate agonists selected from oxycodone, morphine, fentanyl, hydrocodone, codeine, butalbital, tramadol, or combinations thereof, one or more nerve depressants selected from gabapentin, topiramate, lamotrigine, or combinations thereof, and/or other active agents. In one embodiment, the topical composition includes one or more additional active agents selected from one or more antibiotics, antifungals, or antivirals. However, some embodiments may exclude additional active agents. The additional active agents may be provided in powder form (e.g., pure powder or crushed tablets), suspension, gel, solution, or cream, e.g., emulsion. In some embodiments, each additional active agent may be added to 0.1% to 5% by weight of the topical composition.

In some embodiments, the topical composition comprises a topical pain cream, which may include an ointment, gel, or emulsion, comprising cannabidiol. In one example, the topical pain cream comprises at least two commercially available topical solutions that are compounded together. For example, the topical composition may include a commercially available NSAID topical solution and a commercially available local anesthetic topical solution as described herein. The actives may be compounded with a base cream, gel, ointment, lotion, or emulsion. The topical composition may also comprise medicated creams, lotions, gels, ointments, pastes, tablets, bulk powders, or other medicated formats including all or a portion of one or more of the active agents. Thus, the topical composition may include cannabidiol, a local anesthetic agent comprising one or more local anesthetics, and an NSAID agent comprising one or more NSAIDs obtained from commercially available solutions, creams, lotions, gels, ointments, pastes, ground oral tablets, or combination thereof. Some embodiments may also include bulk powders in addition to or instead of commercially available solutions, creams, lotions, gels, ointments, pastes, ground oral tablets, or combination thereof. For example, the topical composition may comprise at least two commercially available medicated topical solutions, a commercially available medicated topical cream (which may include a cream, hydrous ointment, lotion, gel, or emulsion) or anhydrous ointment, and one or more actives comprising bulk powder or ground tablets.

In some embodiments, the topical composition described anywhere herein may further include xylitol and/or one or more poloxamers. Xylitol may be present in a weight percent between about 0.1% and about 5% or in another weight percent described above or elsewhere herein. Poloxamers may be present in a weight percent between about 0.1% and about 5% by weight. In one embodiment, the one or more poloxamers comprise poloxamer 407 and poloxamer 188.

The topical composition may exhibit excellent storage characteristics, and avoid separation and/or degradation of the active ingredients for substantial lengths of time. As noted above, the composition may be in a cream format comprising an aqueous phase and an oil phase. In various embodiments, active ingredients in a topical cream preparation may be in the aqueous phase, oil phase, or both.

As introduced above and elsewhere herein, the topical composition may include a diclofenac, such as diclofenac sodium topical solution, 1.5% (w/w), compounded with lidocaine and prilocaine cream, 2.5%/2.5%. In various embodiments, the topical composition may comprise lidocaine and prilocaine cream, 2.5%/2.5%, in an amount between about 0.2 g and about 0.7 g per gram. For example, the topical composition may comprise between about 0.2 g and about 0.7 g, about 0.2 g and about 0.6 g, about 0.2 g and about 0.5 g, about 0.2 g and about 0.4 g, about 0.2 and about 0.3 g, about 0.3 g and about 0.7 g, about 0.3 g and about 0.6 g, about 0.3 g and about 0.5 g, about 0.3 g and about 0.4 g, about 0.4 g and about 0.7 g, about 0.4 g and about 0.6 g, about 0.4 g and about 0.5 g, about 0.5 g and about 0.6 g, about 0.5 g and about 0.7 g, about 0.6 g and about 0.9 g or greater than or equal to about 0.1 g, about 0.2 g, about 0.3 g, about 0.4 g, about 0.5 g, about 0.7 g, or about 9 g or less than or equal to about 0.9 g, about 0.7 g, about 0.5 g, about 0.4 g, about 0.3 g, about 0.2 g, or about 0.1 g lidocaine and prilocaine cream, 2.5%/2.5%, per gram of topical composition. In one example, the topical composition comprises about 0.1 g, about 0.2 g, about 0.3 g, about 0.4 g, about 0.5 g, about 0.7 g, or about 0.9 g lidocaine and prilocaine cream, 2.5%/2.5%, per gram. In one embodiment, the topical composition comprises between about 0.5 and about 0.9 g lidocaine and prilocaine cream, 2.5%/2.5%, per gram.

In some methods, commercially available lidocaine and prilocaine cream, 2.5%/2.5%, is compounded in an amount between about 0.2 g and about 0.7 g per gram or in a lesser amount together with lidocaine and prilocaine from other sources sufficient to provide between about 5 mg and about 40 mg of each of the lidocaine and prilocaine present in one gram of the topical composition. For example, lidocaine and prilocaine cream, 2.5%/2.5%, may be added in an amount sufficient to provide between about 5 mg and about 23 mg, about 5 mg and about 15 mg, about 5 mg and about 14 mg, about 5 mg and about 12 mg, about 5 mg and about 11 mg, about 5 mg and about 10 mg, about 5 mg and about 9 mg, about 5 mg and about 8 mg, about 5 mg and about 6 mg, about 6 mg and about 16 mg, about 6 mg and about 15 mg, about 6 mg and about 14 mg, about 6 mg and about 12 mg, or about 6 mg and about 22 mg of each of the lidocaine and prilocaine present in one gram of the topical composition. In some embodiments, the amounts of each of lidocaine and prilocaine per gram of the topical composition provided by lidocaine and prilocaine cream, 2.5%/2.5%, is about 1 mg, about 2 mg, about 3 mg, about 4 mg, about 5 mg, about 6 mg, about 7 mg, about 8 mg, about 9 mg, about 10 mg, about 11 mg, about 13 mg, about 14 mg, about 15 mg, about 16 mg, about 17 mg, or about 23 mg. In some embodiments, the amount of lidocaine and/or prilocaine is greater than or equal to about 2.5%. Thus, the topical composition may be formulated to include 25 mg or greater of one or both of lidocaine and prilocaine per gram. In some such embodiments, lidocaine solution or powder and/or prilocaine powder may be used in addition to or instead of lidocaine and prilocaine cream 2.5%/2.5%.

As introduced above and elsewhere herein, the topical composition may comprise cannabidiol and lidocaine hydrochloride topical solution such as commercially available lidocaine hydrochloride topical solution, 4%, compounded with commercially available diclofenac sodium topical solution, 1.5% (w/w), and/or commercially available lidocaine and prilocaine cream, 2.5%/2.5%. The topical composition may include cannabidiol in an amount between about 2.5 mg and about 100 mg, such as between about 2.5 mg and about 50 or between about 4 mg and about 35 mg per gram and lidocaine hydrochloride topical solution, 4%, in an amount between 0 and about 0.5 g per gram. For example, the topical composition may comprise lidocaine hydrochloride topical solution, 4%, or equivalent in an amount between about 0.001 g and about 0.01 g, about 0.005 g and about 0.02 g, about 0.009 g and about 0.02 g, about 0.09 g and about 0.01 g, about 0.01 g and about 0.02, about 0.01 g and about 0.1 g, about 0.1 g and about 0.4 g, about 0.1 g and about 0.3 g, about 0.1 g and about 0.2 g, about 0.2 and about 0.3 g, about 0.3 and about 0.5, about 0.3 g and about 0.4 g, or greater than or equal to about 0.001 g, about 0.01 g, about 0.02 g, about 0.05 g, about 0.1 g, about 0.2 g, about 0.3 g, or about 0.4 g, or less than or equal to about 0.001 g, about 0.01 g, about 0.02 g, about 0.05 g, about 0.1 g, about 0.2 g, about 0.3 g, or about 0.4 g lidocaine hydrochloride topical solution, 4%, per gram of topical composition. In one example, the topical composition comprises about 0.001 g, about 0.01 g, about 0.02 g, about 0.05 g, about 0.1 g, about 0.2 g, about 0.3 g, or about 0.4 g lidocaine hydrochloride topical solution, 4%, per gram.

In some methods, lidocaine hydrochloride topical solution, 4%, is compounded in an amount between 0 g and about 0.7 g per gram of the topical composition or in an amount sufficient to provide between about 1 mg and about 25 mg of the lidocaine present in one gram of the topical composition. For example, lidocaine hydrochloride topical solution, 4%, may be added in an amount sufficient to provide between about between about 0.01 mg and about 0.1 mg, about 0.1 mg and about 3 mg, about 0.1 mg and about 2 mg, about 0.1 mg and about 1 mg, about 0.1 mg and about 0.8 mg, about 0.1 mg and about 0.6 mg, about 0.2 mg and about 0.8 mg, about 0.2 mg and about 0.6 mg, about 0.2 mg and about 0.5 mg, about 0.2 mg and about 0.4 mg, about 0.2 mg and about 0.3 mg, about 0.3 mg and about 0.8 g, about 0.3 mg and about 0.6 mg, about 0.3 mg and about 0.5 mg, about 0.3 mg and about 0.4 mg, about 0.4 mg and about 0.8 mg, about 0.4 mg and about 0.6 mg, about 0.6 mg and about 0.8 mg, about 0.8 mg and about 2 mg, about 1 mg and about 25 mg, about 3 mg about 15 mg, about 3 mg and about 10 mg, about 5 mg and about 15 mg, about 5 mg and about 10 mg, about 10 mg and about 15 mg, about 15 mg and about 25 mg or greater than or equal to about 0.1 mg, about 0.2 mg, about 0.3 mg, about 0.4 mg, about 0.5 mg, about 0.6 mg, about 0.8 mg, or about 0.9 mg, about 1 mg, about 3 mg, about 5 mg, about 10 mg, about 15 mg, about 20 mg or less than or equal to about 0.1 mg, about 0.2 mg, about 0.3 mg, about 0.4 mg, about 0.5 mg, about 0.6 mg, about 0.8 mg, or about 0.9 mg, about 1 mg, about 3 mg, about 5 mg, about 10 mg, about 15 mg, about 20 mg lidocaine per gram of topical composition. In some embodiments, the amount of lidocaine per gram of the topical composition provided by lidocaine hydrochloride topical solution, 4%, is about 0.1 mg, about 0.5 mg, about 1 mg, about 5 mg, about 10 mg, about 15 mg, about 20 mg, or about 25 mg.

As introduced above and elsewhere herein, in some embodiments, the compounded composition may comprise cannabidiol synthetic powder, diclofenac sodium topical solution, 1.5% (w/w), lidocaine and prilocaine cream, 2.5%/2.5%, and lidocaine and/or prilocaine bulk powder. Some embodiments may further include lidocaine hydrochloride topical solution, 4%. The topical composition may include between 0 mg and about 50 mg of each of lidocaine and prilocaine or pharmaceutically acceptable salt or equivalent thereof. For example, the topical composition may comprise between 0 and 50 mg per gram such as between about 1 mg and about 10 mg, about 5 mg and about 15 mg, about 10 mg and about 20 mg, about 15 mg and about 25 mg, about 20 mg and about 30 mg, about 25 mg and about 35 mg, about 30 mg and about 40 mg, about 35 mg and about 45 mg, about 40 mg and about 50 mg, about 5 mg and about 25 mg, about 5 mg and about 30 mg, about 5 mg and about 45 mg, or greater than or equal to about 1 mg, about 3 mg, about 5 mg, about 6 mg, about 8 mg, about 9 mg, about 10 mg, about 11 mg, about 12 mg, about 13 mg, about 14 mg, about 16 mg, about 20 mg, about 25 mg, about 30 mg, about 35 mg, about 40 mg, about 45 mg, or less than or equal to about 3 mg, about 5 mg, about 10 mg, about 15 mg, about 20 mg, about 25 mg, about 30 mg, about 35 mg, about 40 mg, about 45 mg, or about 50 mg per gram of topical composition. In an example, the topical composition includes about 1 mg, about 3 mg, about 5 mg, about 6 mg, about 8 mg, about 9 mg, about 10 mg, about 11 mg, about 12 mg, about 13 mg, about 14 mg, about 16 mg, about 20 mg, about 25 mg, about 30 mg, about 35 mg, about 40 mg, about 45 mg, or about 50 mg of lidocaine per gram of the topical composition from bulk powders such as hydrochloride USP monohydrate, lidocaine solution, 4%, lidocaine cream, 4%, lidocaine and prilocaine cream, 2.5%/2.5%, or combination thereof.

Additionally or alternatively, the topical composition may include between 1 mg and about 50 mg per gram of prilocaine or pharmaceutically acceptable salt or equivalent thereof from bulk powder. For example, the topical composition may comprise prilocaine hydrochloride USP powder in an amount between 1 mg and 50 mg per gram such as between about 1 mg and about 10 mg, about 5 mg and about 15 mg, about 10 mg and about 20 mg, about 15 mg and about 25 mg, about 20 mg and about 30 mg, about 25 mg and about 35 mg, about 30 mg and about 40 mg, about 35 mg and about 45 mg, about 40 mg and about 50 mg, about 5 mg and about 25 mg, about 5 mg and about 30 mg, about 5 mg and about 45 mg, or greater than or equal to about 1 mg, about 3 mg, about 5 mg, about 6 mg, about 8 mg, about 9 mg, about 10 mg, about 11 mg, about 12 mg, about 13 mg, about 14 mg, about 16 mg, about 20 mg, about 25 mg, about 30 mg, about 35 mg, about 40 mg, about 45 mg, or less than or equal to about 3 mg, about 5 mg, about 10 mg, about 15 mg, about 20 mg, about 25 mg, about 30 mg, about 35 mg, about 40 mg, about 45 mg, or about 50 mg per gram of topical composition. In an example, the topical composition includes about 1 mg, about 3 mg, about 5 mg, about 6 mg, about 8 mg, about 9 mg, about 10 mg, about 11 mg, about 12 mg, about 13 mg, about 14 mg, about 16 mg, about 20 mg, about 25 mg, about 30 mg, about 35 mg, about 40 mg, about 45 mg, or about 50 mg of prilocaine hydrochloride USP powder per gram of topical composition. Other bulk powders of prilocaine salts or pharmaceutical equivalents may be used in addition or alternatively to prilocaine hydrochloride USP in weights providing like amounts of prilocaine active.

Various embodiments of the topical composition may include about equivalent amounts of lidocaine and prilocaine by weight of the topical composition. Some embodiments may include unmatched amounts of lidocaine and prilocaine.

In one embodiment, a method of making the topical composition may include combining the contents of a capsule comprising cannabidiol synthetic powder and xylitol and/or poloxamer with a solution, suspension, cream, gel, ointment, lotion, or emulsion. The capsule may include between about 5 mg and about 100 mg, such as between about 10 mg and about 50 mg cannabidiol, for example. The solution, suspension, cream, gel, ointment, lotion, or emulsion may comprise a commercially available base or medicated composition. Ointments may include petrolatum, mineral oil, paraffins, synthetic hydrocarbons, water washable ointments, hydrophilic ointments, water containing ointments or ointments devoid of water. Solutions or suspensions may comprise aqueous or non-aqueous solutions. In a further embodiment, the method of making the topical composition comprises combining one or more additional active agents. The one or more additional active agents may be selected from any active agents, such as those and in amounts described herein. The method may include combining the contents of the capsule with the one or more additional active agents within a solution, cream, gel, ointment, lotion, or emulsion or combining with the same to formulate the topical composition. Some embodiments may include other additional components or composition thereof in addition to or instead of those identified above and elsewhere herein. In various embodiments, the topical composition comprises cannabidiol, an NSAID agent, and a local anesthetic agent. The representative amount of cannabidiol, NSAID, and local anesthetic active agents and actives thereof, e.g., diclofenac, lidocaine, and prilocaine, in the topical composition may be as described above and elsewhere herein. For example, the capsule may be combined with diclofenac, lidocaine, and prilocaine to formulate a topical composition comprising between about 1% and about 1.5% diclofenac, between about 1.9% and about 2.5% lidocaine, and between about 1.9% and about 2.5% prilocaine by weight. In an example, the capsule may be combined with a cream containing about 1.5% diclofenac, 2.5% lidocaine, and 2.5% prilocaine by weight. In one example, the topical composition comprises between about 0.5% and about 20% cannabidiol, such as between about 2% and about 17% cannabidiol by weight.

Various examples of a topical composition comprising between about 0.1% and about 20% cannabidiol, between about 0.1% and about 4% diclofenac, between about 0.1% and about 4% lidocaine, and between about 0.1% and about 4% prilocaine by weight are described below and elsewhere herein. In such examples, the topical composition may be compounded by combining commercially available compositions including the actives such as diclofenac sodium topical solution, 1.5% (w/w), and lidocaine and prilocaine 2.5%/2.5%. Further examples may also include combining lidocaine hydrochloride topical solution, 4%. Further examples may additionally or alternatively include diclofenac sodium USP powder, lidocaine hydrochloride USP monohydrate powder, prilocaine hydrochloride USP powder, or combination thereof.

In one example, the topical composition comprises a topical pain cream comprising between about 0.5% and about 20% cannabidiol, between about 0.5% and about 2% diclofenac sodium, between about 1% and about 3% lidocaine, and between about 1% and about 3% prilocaine by weight.

In another example, the topical composition comprises a topical pain cream comprising between about 0.1% and about 17% cannabidiol, between about 0.75% and about 2% diclofenac sodium, between about 1.5% and about 3% lidocaine, and between about 1.5% and about 3% prilocaine by weight.

In another example, the topical composition comprises a topical pain cream comprising between about 2% and about 17% cannabidiol, between about 1% and about 2% diclofenac sodium, between about 2% and about 3% lidocaine, and between about 2% and about 3% prilocaine by weight.

In another example, the topical composition comprises a topical pain cream comprising between about 2% and about 15% cannabidiol, between about 1.25% and about 2% diclofenac sodium, between about 1.5% and about 3% lidocaine, and between about 1.5% and about 3% prilocaine by weight.

In another example, the topical composition comprises a topical pain cream comprising between about 3.3% and about 15% cannabidiol, between about 1% and about 1.75% diclofenac sodium, between about 1.75% and about 3% lidocaine, and between about 1.75% and about 3% prilocaine by weight.

In another example, the topical composition comprises a topical pain cream comprising between about 2% and about 17% cannabidiol, between about 1.25% and about 1.75% diclofenac sodium, between about 1.75% and about 3% lidocaine, and between about 1.75% and about 3% prilocaine by weight.

In another example, the topical composition comprises a topical pain cream comprising between about 2% and about 10% cannabidiol, between about 1.25% and about 1.75% diclofenac sodium, between about 2% and about 3% lidocaine, and between about 2% and about 3% prilocaine by weight.

In another example, the topical composition comprises a topical pain cream comprising between about 0.5% and about 5% cannabidiol, between about 1.5% and about 2% diclofenac sodium, between about 2.25% and about 3% lidocaine, and between about 2.25% and about 3% prilocaine by weight.

In another example, the topical composition comprises a topical pain cream comprising between about 2% and about 20% cannabidiol, between about 1.5% and about 2% diclofenac sodium, between about 2.5% and about 3% lidocaine, and between about 2.5% and about 3% prilocaine by weight.

In another example, the topical composition comprises a topical pain comprising between about 2% and about 17% cannabidiol and greater than or equal to each of about 1.15% diclofenac sodium, about 2% lidocaine, and about 2% prilocaine by weight.

In another example, the topical composition comprises a topical pain cream comprising between about 2% and about 20% cannabidiol and greater than or equal to each of about 1.5% diclofenac sodium, about 2.5% lidocaine, and about 1.5% prilocaine by weight.

In another example, the topical composition comprises a topical pain cream comprising between about 2% and about 20% cannabidiol and greater than about 4% diclofenac sodium, less than about 4% lidocaine, and less than about 4% prilocaine by weight.

Some embodiments of the above examples may include about equivalent amounts of lidocaine and prilocaine by weight of the topical composition.

In the above examples, or in other examples or embodiments described herein, compounding the topical composition may comprise combining about 5 mg and about 50 mg cannabidiol, at least diclofenac sodium topical solution, 1.5% (w/w), lidocaine and prilocaine cream, 2.5%/2.5%, as well as combining one or more of diclofenac sodium UPS bulk powder, lidocaine hydrochloride topical solution, 4%, lidocaine hydrochloride USP monohydrate powder, or prilocaine hydrochloride USP powder in amounts described in the following paragraphs and elsewhere herein. In some embodiments, the cannabidiol comprises cannabidiol synthetic analogue powder. In one embodiment, the cannabidiol is provided in a capsule including xylitol and/or poloxamer as described elsewhere herein.

Diclofenac sodium topical solution, 1.5% (w/w), may be combined in an amount between about 10% and about 75% diclofenac sodium topical solution, 1.5% (w/w), by weight of the topical composition, for example between about 10% and about 65%, about 20% and about 50%, about 20% and about 60%, about 30% and about 60%, about 30% and about 55%, about 30% and about 50%, or about 35% and about 45%, or a non-zero percent less than or equal to about 70%, about 60%, about 50%, about 45%, about 40%, about 35%, about 25%, about 15% by weight of the topical composition. In some embodiments, diclofenac sodium topical solution, 1.5% (w/w), may be compounded in an amount about 15%, about 20%, about 25%, about 30%, about 35%, about 40%, about 45%, about 50%, about 55%, about 60%, about 65%, or about 70% by weight of the topical composition.

Lidocaine and prilocaine cream, 2.5%/2.5%, may be combined in an amount between about 10% and about 90% lidocaine and prilocaine cream, 2.5%/2.5%, by weight of the topical composition, for example between about 20% and about 85%, about 20% and about 65%, about 25% and about 60%, about 30% and about 60%, about 35% and about 60%, about 40% and about 50%, about 45% and about 60%, or about 45% and about 55%, about 50% and about 90%, about 50% and about 80%, about 50% and about 70%, about 60% and about 90%, about 60% and about 80%, about 70% and about 90%, or a non-zero percent less than or equal to about 90%, about 80%, about 70, about 60%, about 50%, about 45%, about 40%, about 35%, about 25%, or about 15% by weight of the topical composition. In some embodiments, lidocaine and prilocaine cream, 2.5%/2.5%, may be compounded in an amount about 15%, about 20%, about 25%, about 30%, about 35%, about 40%, about 45%, about 50%, about 53%, about 55%, about 60%, about 65%, or about 70% by weight of the topical composition. Some embodiments may include at least 50% lidocaine and prilocaine cream, 2.5%/2.5%, which in some embodiments may include greater than 75% lidocaine and prilocaine cream, 2.5%/2.5%, by weight.

Diclofenac sodium topical solution, 1.5% (w/w), and lidocaine and prilocaine cream, 2.5%/2.5%, may be combined in a combined amount greater than about 50%, about 60%, about 75%, about 80%, about 85%, about 90%, or about 95% by weight of the topical composition. Examples may include diclofenac sodium topical solution, 1.5% (w/w), and lidocaine and prilocaine cream, 2.5%/2.5%, combined together in an amount between about 50% and about 95%, about 60% and about 95%, about 75% and about 95%, about 80% and about 95%, about 85% and about 90%, about 90% and about 95% or less than about 96%, about 95%, about 93%, about 91%, about 85%, about 80%, about 75%, about 70%, or about 60% by weight of the topical composition. Further examples, may include diclofenac sodium topical solution, 1.5% (w/w), and lidocaine and prilocaine cream, 2.5%/2.5%, combined together in an amount about 95%, about 94%, about 93%, about 92%, about 91%, about 90%, about 85%, about 80%, about 75%, about 70%, or about 60% by weight of the topical composition.

Lidocaine and prilocaine cream, 2.5%/2.5%, and diclofenac sodium topical solution, 1.5% (w/w), may be combined at a weight ratio of between about 5:1 and about 1:5, for example between about 4:1 and about 1:4, about 3:1 and about 1:3, about 2:1 and about 1:2, about 1.5:1 and about 1:1, about 1.3:1 and about 1:1, about 1:1 and about 1:1.5, about 1:1.3, or about 1:1 and about 1:1.5. In some embodiments, lidocaine and prilocaine cream, 2.5%/2.5%, and diclofenac sodium topical solution, 1.5% (w/w), may be combined at a weight ratio of about 5:1, about 4:1, about 3:1, about 2:1, about 1.5:1, about 1.3:1, about 1:1, about 1:1.3, about 1:1.5, about 1:2, about 1:3, about 1:4, or about 1:5.

Lidocaine hydrochloride topical solution, 4%, may be combined in an amount between 0 and about 20%, or between about 1% and about 7%, by weight of the topical composition, for example between about 1% and about 17%, about 1% and about 15%, about 1% and about 12%, about 1% and about 10%, about 1% and about 7%, about 1% and about 5%, about 1% and about 3%, about 2% and about 7%, or a non-zero percent less than or equal to about 20%, about 18%, about 15%, about 13%, about 10%, about 7%, about 5%, or about 3% by weight of the topical composition. In some embodiments, lidocaine hydrochloride topical solution, 4%, may be compounded in an amount about 20%, about 18%, about 15%, about 13%, about 10%, about 7%, about 5%, about 3%, about 2%, or about 0.9% by weight of the topical composition.

Lidocaine and prilocaine cream, 2.5%/2.5%, and lidocaine hydrochloride topical solution, 4%, may be combined in some examples at a weight ratio of between about 800:1 and about 1:4, for example between about 800:1 and about 1:2, about 400:1 and about 1:1, about 400:1 and about 10:1, about 200:1 and about 10:1, about 100:1 and about 10:1, about 75:1 and about 10:1, about 60:1 and about 25:1, about 55:1 and about 35:1, about 55:1 and about 40:1, about 55:1 and about 45:1, or about 53:1 and about 50:1. In some embodiments, lidocaine and prilocaine cream, 2.5%/2.5%, and lidocaine hydrochloride topical solution, 4%, may be combined at a weight ratio of about 800:1, about 400:1, about 200:1, about 100:1, about 75:1, about 65:1, about 60:1, about 55:1, about 53:1, about 52:1, about 50:1, about 45:1, about 40:1, about 30:1, about 20:1, about 4:1, about 2:1, about 1:1, about 1:2, or about 1:4.

Diclofenac sodium USP powder may be combined in an amount between 0 and about 10%, or between about 0.5% and about 5%, by weight of the topical composition, for example between about 0.1% and about 5%, about 1% and about 5%, about 1% and about 3%, about 1% and about 2%, about 2% and about 5%, about 2% and about 3%, about 0.5% and about 1.5%, or about 0.5% and about 1%, or a non-zero percent less than or equal to about 5%, about 4.5%, about 3.5%, about 2.5%, about 2%, about 1.5%, about 1.4%, about 1.1%, about 1.0%, about 0.8%, about 0.6%, about 0.5%, or about 0.1% by weight of the topical composition. In some embodiments, diclofenac sodium USP powder may be compounded in an amount about 5%, about 4.5%, about 3.5%, about 2.5%, about 2%, about 1.5%, about 1.4%, about 1.1%, about 1.0%, about 0.8%, about 0.6%, about 0.5%, or about 0.1% by weight of the topical composition.

Diclofenac sodium topical solution, 1.5% (w/w), and diclofenac sodium USP powder may be combined at a weight ratio of between about 800:1 and about 1:4, for example between about 400:1 and about 1:2, about 200:1 and about 1:1, about 100:1 and about 1:1, about 75:1 and about 10:1, about 60:1 and about 25:1, about 50:1 and about 35:1, about 45:1 and about 35:1, or about 42:1 and about 38:1. In some embodiments, diclofenac sodium topical solution, 1.5% (w/w), and diclofenac sodium USP powder may be combined at a weight ratio of about 800:1, about 400:1, about 200:1, about 100:1, about 75:1, about 60:1, about 50:1, about 45:1, about 42:1, about 40:1, about 38:1, about 35:1, about 25:1, about 10:1, about 1:1, or about 4:1.

Lidocaine hydrochloride USP monohydrate powder may be combined in an amount between 0 and about 6%, or between about 0.75% and about 5%, by weight of the topical composition, for example between about 0.5% and about 5%, about 0.5% and about 4.5%, about 0.5% and about 3.5%, about 0.5% and about 2.5%, about 0.5% and about 1.5%, about 1.5% and about 5%, about 1.5% and about 3.5%, about 2% and about 5%, about 3.5% and about 5%, or a non-zero percent less than or equal to about 6%, about 5%, about 4%, about 3.5%, about 3%, about 2.5%, about 2%, about 1.75%, about 1.5%, about 1.25%, about 1%, or about 0.5% by weight of the topical composition. In some embodiments, lidocaine hydrochloride USP monohydrate powder may be compounded in an amount about 6%, about 5%, about 4%, about 3.5%, about 3%, about 2.5%, about 2%, about 1.75%, about 1.5%, about 1.25%, about 1%, or about 0.5% by weight of the topical composition.

Lidocaine and prilocaine cream, 2.5%/2.5%, and lidocaine hydrochloride USP monohydrate powder may be combined in some examples at a weight ratio of between about 800:1 and about 1:4, for example between about 800:1 and about 1:2, about 400:1 and about 1:1, about 400:1 and about 10:1, about 200:1 and about 10:1, about 100:1 and about 10:1, about 75:1 and about 10:1, about 60:1 and about 25:1, about 55:1 and about 30:1, about 50:1 and about 30:1, about 45:1 and about 35:1, or about 40:1 and about 35:1. In some embodiments, lidocaine and prilocaine cream, 2.5%/2.5%, and lidocaine hydrochloride USP monohydrate powder may be combined at a weight ratio of about 800:1, about 400:1, about 200:1, about 100:1, about 75:1, about 65:1, about 60:1, about 55:1, about 50:1, about 45:1, about 40:1, about 38:1, about 35:1, about 30:1, about 20:1, about 4:1, about 2:1, about 1:1, about 1:2, or about 1:4.

Prilocaine hydrochloride USP powder may be combined in an amount between 0 and about 6%, or between about 0.75% and about 5%, by weight of the topical composition, for example between about 0.5% and about 5%, about 0.5% and about 4.5%, about 0.5% and about 3.5%, about 0.5% and about 2.5%, about 0.5% and about 1.5%, about 1.5% and about 5%, about 1.5% and about 3.5%, about 2% and about 5%, about 3.5% and about 5%, or a non-zero percent less than or equal to about 6%, about 5%, about 4%, about 3.5%, about 3%, about 2.5%, about 2%, about 1.75%, about 1.5%, about 1.25%, about 1%, or about 0.5% by weight of the topical composition. In some embodiments, prilocaine hydrochloride USP powder may be compounded in an amount about 6%, about 5%, about 4%, about 3.5%, about 3%, about 2.5%, about 2%, about 1.75%, about 1.5%, about 1.25%, about 1%, or about 0.5% by weight of the topical composition.

Lidocaine and prilocaine cream, 2.5%/2.5%, and prilocaine hydrochloride USP powder may be combined in some examples at a weight ratio of between about 800:1 and about 1:4, for example between about 800:1 and about 1:2, about 400:1 and about 1:1, about 400:1 and about 10:1, about 200:1 and about 10:1, about 100:1 and about 10:1, about 75:1 and about 10:1, about 60:1 and about 25:1, about 55:1 and about 30:1, about 50:1 and about 30:1, about 45:1 and about 35:1, or about 40:1 and about 35:1. In some embodiments, lidocaine and prilocaine cream, 2.5%/2.5%, and prilocaine hydrochloride USP powder may be combined at a weight ratio of about 800:1, about 400:1, about 200:1, about 100:1, about 75:1, about 65:1, about 60:1, about 55:1, about 50:1, about 45:1, about 40:1, about 38:1, about 35:1, about 30:1, about 20:1, about 4:1, about 2:1, about 1:1, about 1:2, or about 1:4.

The example topical compositions may also include one or more additional components such as one or more of stabilizers or preservatives, thickeners, surfactants, emulsifiers, solubilizes, skin or penetrant enhancers, emollients, or gelling agents. Stabilizers or preservatives may include, for example, one or more of disodium EDTA or a paraben (e.g., methylparaben, propylparaben). In one embodiment, the compounded composition includes one or both of methylparaben or propylparaben. Thickening, which may include gelling, agents may be added to increase viscosity, consistency, or thicken the composition to formulate a lotion, cream, or gel and may include, for example, one or more of acrylic acid or an acrylate, carbomer, carboxypolymethylene, hydroxyethyl cellulose, microcrystalline cellulose, carboxymethylcellulose, polyethylene glycol, waxes, or titanium dioxide. In various embodiments, the topical composition comprises between about 0.5% and about 7% thickening agent by weight, such as between about 1% and about 5%. Surfactants or emulsifiers may also be added to emulsify or improve consistency and may include, for example, one or more of an acrylic, carbomer, polysorbate (e.g., polysorbate 85, polysorbate 20), or emulsifying wax. Solubilizers may include, for example, alcohols or dimethyl isosorbide. Skin or penetrant enhancers may include, for example, one or more of DMSO or isopropyl myristate. In some embodiments, the topical composition may comprise xylitol, poloxamers, or both. In one example, the topical composition may include a blend of micronized xylitol and poloxamers sold under the mark LOXASPERSE®. In one such example, LOXASPERSE® is present in an amount between about 0.05% and about 2% by weight. Some embodiments may include other additional components or composition thereof in addition to or instead of those identified above and elsewhere herein. In some embodiments, LOXASPERSE®

In some embodiments, the example topical composition comprises between 0.5% and 20% by weight of one or more additional actives, such as anticonvulsants, nerve depressants, muscle relaxants, NMDA (N-Methyl-D-aspartate) receptor antagonists, opiate or opioid agonists, antidepressants, and/or other active agents.

In one embodiment, the topical composition may comprise between about 0.25% and about 20% cannabidiol, about 1.25% diclofenac sodium, about 2.25% lidocaine, and about 2.25% prilocaine by weight.

In one such example, the topical composition comprises a topical pain cream having between about 5 mg and about 100 mg or between about 10 mg and about 50 mg cannabidiol, about 0.4 g diclofenac sodium 1.5% solution, about 0.009 g diclofenac sodium USP powder, about 0.528 g lidocaine and prilocaine cream, 2.5%/2.5%, about 0.014 g lidocaine hydrochloride USP monohydrate, about 0.01 g lidocaine hydrochloride 4% solution, and about 0.0138 g prilocaine hydrochloride USP per gram of the topical composition. Each gram of the topical composition may include about 15 mg diclofenac sodium and about 25 mg of each of lidocaine and prilocaine. The topical composition comprises about 40% by weight diclofenac sodium 1.5% solution providing about 6 mg diclofenac sodium, about 0.9% by weight diclofenac sodium USP powder providing about 9 mg diclofenac sodium, about 52.8% by weight lidocaine and prilocaine cream, 2.5%/2.5%, providing about 13.2 mg of each of lidocaine and prilocaine, about 1.4% by weight lidocaine hydrochloride USP monohydrate providing about 11.4 mg of lidocaine, about 1% by weight lidocaine hydrochloride, 4%, solution providing about 0.4 mg of lidocaine, and about 1.38% by weight prilocaine hydrochloride USP providing about 13.2 mg of prilocaine. In an another embodiment, the compounded composition does not include lidocaine hydrochloride topical solution, 4%, and includes about 0.0145 g or about 1.45% by weight lidocaine hydrochloride USP monohydrate providing about 11.8 mg lidocaine. In one formulation, a topical base cream is used instead of or in addition to lidocaine and prilocaine cream, 2.5%/2.5%.

In one embodiment, the topical composition may comprise between about 0.5% and about 20% cannabidiol, about 1.5% diclofenac sodium, about 3% lidocaine, and about 3% prilocaine by weight.

In one such example, the topical composition comprises a topical pain cream having about 0.3 g diclofenac sodium 1.5% solution, about 0.0105 g diclofenac sodium USP powder, about 0.65 g lidocaine and prilocaine cream, 2.5%/2.5%, about 0.012 g lidocaine hydrochloride USP monohydrate, about 0.1 g lidocaine hydrochloride, 4%, solution, and about 0.016 g prilocaine hydrochloride USP per gram of the topical composition. Each gram of the topical composition may include about 15 mg diclofenac sodium and about 30 mg of each of lidocaine and prilocaine. The topical composition comprises about 30% by weight diclofenac sodium 1.5% solution providing about 4.5 mg diclofenac sodium, about 1.05% by weight diclofenac sodium USP powder providing about 10.5 mg diclofenac sodium, about 65% by weight lidocaine and prilocaine cream, 2.5%/2.5%, providing about 16.75 mg of each of lidocaine and prilocaine, about 1.2% by weight lidocaine hydrochloride USP monohydrate providing about 12 mg of lidocaine, about 10% by weight lidocaine hydrochloride, 4%, solution providing about 4 mg of lidocaine, and about 1.6% by weight prilocaine hydrochloride USP providing about 13.75 mg of prilocaine. In an another embodiment, the compounded composition does not include lidocaine hydrochloride topical solution, 4%, and includes about 0.017 g or about 1.7% by weight lidocaine hydrochloride USP monohydrate providing about 13.75 mg lidocaine. In one formulation, a topical base cream is used instead of or in addition to lidocaine and prilocaine cream, 2.5%/2.5%.

The above example embodiments of the topical composition may also include a thickening agent, a preservative, or both. For example, the thickening agent may comprise between about 1% and about 5% by weight of the topical composition. For example, between about 1% and about 5% by weight hydroxyethyl cellulose. In one embodiment, the thickening agent may comprise hydroxyethyl cellulose is an amount about 0.02 g per gram of topical composition. The preservative may include paraben. For example, the preservative may comprise methylparaben, propylparaben, or both. In one formulation methylparaben is combined in an amount between about 0.1 mg and about 1 mg, e.g., about 0.25 mg, and propylparaben is combined in an amount between 0.1 mg and about 1 mg, e.g., about 0.125 mg, per gram of the topical composition. Xylitol, poloxamers, or both may also be included. For example, the topical composition may include between 1 mg and 20 mg of xylitol, poloxamers, or both. In one embodiment, the topical composition contains up to 5% LOXASPERSE®, such as about 5 mg LOXASPERSE®. In at least one embodiment, the topical composition includes greater than 5% LOXASPERSE® by weight.

Combining the ingredients may include mixing the ingredients to generate a smooth consistent cream. In one example, the ingredients may be added to a mixing bowl and then mixed to thoroughly wet powders with the cream and/or solutions. The mixed ingredients may be further milled, for example, with a three-roll mill and then packaged.

Some embodiments may not include a commercially available lidocaine solution such as a lidocaine hydrochloride topical solution, 4%. One such embodiment or another embodiment may not include one or more of a lidocaine, prilocaine, or diclofenac bulk powder. A method of making an above or another embodiment of the topical composition described herein, may not include combining additional thickening agents, preservatives, or both, not already present in the combined commercially available medicated compositions, e.g., diclofenac sodium topical solution, 1.5% (w/w), lidocaine hydrochloride topical solution, 4%, or lidocaine and prilocaine cream, 2.5%/2.5%.

In various embodiments, the topical pain cream may also include one or more active drugs selected from an local anesthetics, NSAIDS, analgesics, antidepressants, anticonvulsants, opioids, NMDA receptor antagonists, muscle relaxants, or combination thereof.

For example, the topical composition may include a topical pain cream including cannabidiol, lidocaine hydrochloride topical solution, 4% and one or more additional actives comprising an NSAID wherein the NSAID is selected from one or more salicylic acid derivatives (e.g., aspirin, diflunisal, salsalate, trilisate), one or more propionic acids (e.g., flurbiprofen, ibuprofen, ketoprofen, naproxen, oxaprozin), one or more acetic acids (e.g., diclofenac, etodolac, indomethacin, ketorolac, nabumetone, sulindac, tolmetin), one or more fenamates (e.g., meclofenamate), one or more oxicams (meloxicam, piroxicam), or one or more COX-2 inhibitors (e.g., celecoxib, rofecoxib, valdecoxib), or combinations thereof. For example, in one embodiment, the topical composition comprises a topical pain cream including xylitol, poloxamer, and one or more actives comprising an comprising a benzeneacetic acid derivative such as diclofenac. Various embodiments may include between about 0.01% and about 20% by weight NSAID.

In an above or another example, the topical composition may include a topical pain cream including cannabidiol, lidocaine hydrochloride topical solution, 4% and one or more actives comprising a local anesthetic selected from lidocaine, prilocaine, benzocaine, or combination thereof. Various embodiments may include between about 0.01% and about 10% by weight local anesthetic.

In an above or another example, the topical composition may include a topical pain cream including cannabidiol, lidocaine hydrochloride topical solution, 4% and one or more actives comprising an anticonvulsant, which may include nerve depressant, selected from gabapentin, topiramate, lamotrigine, or combinations thereof. In various embodiments, the anticonvulsant or nerve depressant agent may comprise between about 0.01% and about 20% by weight of the topical pain cream.

In an above or another example, the topical composition may include a topical pain cream including cannabidiol, lidocaine hydrochloride topical solution, 4% and one or more actives comprising a NMDA receptor antagonists such as ketamine.

In an above or another example, the topical composition may include a topical pain cream including cannabidiol, lidocaine hydrochloride topical solution, 4% and one or more actives comprising an opiate, which may include an opioid agonist, selected from tramadol; one or more C2 opiate agonists selected from oxycodone, morphine, methadone, hydromorphone, and fentanyl; one or more C3 opiate agonists selected from hydrocodone, codeine, propoxyphene, butalbital, and pentazocine; or any combination thereof.

In an above or another example, the topical composition may include a topical pain cream including cannabidiol, lidocaine hydrochloride topical solution, 4% and one or more actives comprising a muscle relaxant comprising one or more muscle relaxants selected from baclofen, carisoprodol, chlorzoxazone, cyclobenzaprine, dantrolene, diazepam, metaxalone, methocarbamol, orphenadrine, quinine sulfate, tizanidine, and/or other muscle relaxants. In various embodiments, the muscle relaxant agent comprises between about 0.001% and about 5% by weight of the topical pain cream.

In an above or another example, the topical composition may include a topical pain cream including cannabidiol, lidocaine hydrochloride topical solution, 4% and one or more actives including a NSAID including diclofenac and a local anesthetic including lidocaine and prilocaine. In one embodiment, lidocaine may be provided by a lidocaine solution, lidocaine and prilocaine cream, lidocaine bulk powder, or both. Diclofenac may be provided by a diclofenac solution, diclofenac bulk powder, or both, for example. In a further embodiment, the composition may include xylitol, one or more poloxamers, or both.

In various embodiments, a method of compounding a topical pain cream comprises formulating a cream comprises combining cannabidiol at a weight percent between about 0.1% and about 20% and lidocaine hydrochloride topical solution, 4% in a weight percent between about 0.1% and about 7% or in another weight percent described above or elsewhere herein. The method may also include combining one or more active drugs introduced above selected from an analgesics, local anesthetics, NSAIDS, antidepressants, anticonvulsants, opioids, NMDA receptor antagonists, muscle relaxants, or combination thereof.

In one example, the method includes combining the ingredients with a cream base or another base that when mixed with the ingredients, which may include additional ingredients such as thickeners, water, alcohol, solvents, emulsifiers, emollients, for example, generates a cream. For example, ingredients including water or alcohol may be combined with an anhydrous base. In some embodiments, the base includes a commercially available base, such as a cream base, for compounding. In one embodiment, all or a portion of the base portion, such as a cream base, is provided by a commercially available medicated topical cream, ointment, paste, or solution. In one example, the method includes combining the ingredients with components of a cream base, such as thickeners, surfactants, emulsifiers, water, alcohol, solvents, oils, waxes, hydrocarbons, emollients, or combination thereof. Thickening or gelling agents may include, for example, one or more of acrylic acid or an acrylate, carbomer, carboxypolymethylene, cellulose, hydroxyethyl cellulose, microcrystalline cellulose, carboxymethylcellulose, polyethylene glycol, stearyl palmitate, cetyl alcohol, waxes, titanium dioxide, or combination thereof. Some embodiments may include other thickening or gelling agents may be used in addition to or instead of those identified above and elsewhere herein. Surfactants or emulsifiers may include, for example, one or more of an acrylic, carbomer, polysorbate (e.g., polysorbate 85, polysorbate 20), sorbitan stearate, glyceryl stearate, stearic acid, or emulsifying wax. Some embodiments may include other surfactants or emulsifiers in addition to or instead of those identified above and elsewhere herein. Solvents may include, for example, alcohols or dimethyl isosorbide.

Some embodiments may include addition of one or more of stabilizers or preservatives, solubilizes, skin or penetrant enhancers, emollients, or combination thereof. Some embodiments may include other solvents in addition to or instead of those identified above and elsewhere herein. Stabilizers or preservatives may include, for example, one or more of disodium EDTA or a paraben (e.g., methylparaben, propylparaben). Some embodiments may include other stabilizers in addition to or instead of those identified above and elsewhere herein. Skin penetrant enhancers may include, for example, one or more of DMSO or isopropyl myristate. Some embodiments may include other skin penetrant enhancers in addition to or instead of those identified above and elsewhere herein. Emollients may include, for example, natural oils, mineral oil, castor oil, hydrocarbons, antioxidants, lanolin alcohol, or combination thereof. Some embodiments may include other emollients in addition to or instead of those identified above and elsewhere herein.

In various embodiments, the topical composition may include a topical pain cream, solution, suspension, gel, emulsion, or ointment comprising cannabidiol, xylitol and one or more poloxamers and/or one or more active drugs selected from an local anesthetics, NSAIDS, analgesics, antidepressants, anticonvulsants, opioids, NMDA receptor antagonists, muscle relaxants, or combination thereof.

In various embodiments, the topical composition comprises a topical pain cream including cannabidiol and a combination of xylitol and one or more poloxamers. The combination of xylitol and one or more poloxamers may be present in a non-zero amount to about 10% by weight, such as between about 0.5% and about 10%, about 0.5% and about 7%, about 0.5% and about 5%, about 0.5% and about 2%, about 1% and about 10%, about 0.5% and about 7%, about 1% and about 5%, about 1% and about 3%, about 2% and about 7%, about 2% and about 5%, about 3% and about 7%, or about 3% and about 5% by weight of the topical pain cream. In one embodiment, the one or more poloxamers comprise poloxamer 407 and poloxamer 188.

For example, the topical composition comprises a topical pain cream solution, suspension, gel, emulsion, or ointment including cannabidiol, xylitol, and one or more poloxamers and/or one or more actives comprising an NSAID wherein the NSAID is selected from one or more salicylic acid derivatives (e.g., aspirin, diflunisal, salsalate, trilisate), one or more propionic acids (e.g., flurbiprofen, ibuprofen, ketoprofen, naproxen, oxaprozin), one or more acetic acids (e.g., diclofenac, etodolac, indomethacin, ketorolac, nabumetone, sulindac, tolmetin), one or more fenamates (e.g., meclofenamate), one or more oxicams (meloxicam, piroxicam), or one or more COX-2 inhibitors (e.g., celecoxib, rofecoxib, valdecoxib), or combinations thereof. For example, in one embodiment, the topical composition comprises a topical pain cream solution, suspension, gel, emulsion, or ointment including cannabidiol, xylitol, poloxamer, and one or more actives comprising an comprising a benzeneacetic acid derivative such as diclofenac. Various embodiments may include between about 0.01% and about 20% by weight NSAID.

In an above or another example, the topical composition comprises a topical pain cream including cannabidiol, xylitol and/or one or more poloxamers and one or more actives comprising a local anesthetic selected from lidocaine, prilocaine, benzocaine, or combination thereof. Various embodiments may include between about 0.01% and about 10% by weight local anesthetic.

In an above or another example, the topical composition comprises a topical pain poloxamer, and one or more actives comprising an anticonvulsant, which may include nerve depressant, selected from gabapentin, topiramate, lamotrigine, or combinations thereof. In various embodiments, the anticonvulsant or nerve depressant agent may comprise between about 0.01% and about 20% by weight of the topical pain cream.

In an above or another example, the topical composition comprises a topical pain cream solution, suspension, gel, emulsion, or ointment including cannabidiol, xylitol, poloxamer, and one or more actives comprising a NMDA receptor antagonists such as ketamine.

In an above or another example, the topical composition comprises a topical pain cream solution, suspension, gel, emulsion, or ointment including cannabidiol, xylitol, poloxamer, and one or more actives comprising an opiate, which may include an opioid agonist, selected from tramadol; one or more C2 opiate agonists selected from oxycodone, morphine, methadone, hydromorphone, and fentanyl; one or more C3 opiate agonists selected from hydrocodone, codeine, propoxyphene, butalbital, and pentazocine; or any combination thereof.

In an above or another example, the topical composition comprises a topical pain cream solution, suspension, gel, emulsion, or ointment including cannabidiol, xylitol, poloxamer, and one or more actives comprising a muscle relaxant comprising one or more muscle relaxants selected from baclofen, carisoprodol, chlorzoxazone, cyclobenzaprine, dantrolene, diazepam, metaxalone, methocarbamol, orphenadrine, quinine sulfate, tizanidine, and/or other muscle relaxants. In various embodiments, the muscle relaxant agent comprises between about 0.001% and about 5% by weight of the topical pain cream.

In an above or another example, the topical composition comprises a topical pain poloxamer, and one or more actives including a NSAID including diclofenac and a local anesthetic including lidocaine and prilocaine. In one embodiment, lidocaine may be provided by a lidocaine solution, lidocaine and prilocaine cream, lidocaine bulk powder, or both. Diclofenac may be provided by a diclofenac solution, diclofenac bulk powder, or both, for example. In one example, cannabidiol is present in an amount between about 0.25% and about 5%, diclofenac is present in an amount between about 1% and about 2%, and lidocaine and prilocaine are each present in an amount between about 2% and about 3% by weight.

In various embodiments, a method of compounding a topical pain cream comprises formulating a cream comprising combining cannabidiol, xylitol, and one or more poloxamers in a weight percent between about 0.1% and about 25% or in another weight percent described above or elsewhere herein. In one embodiment, the one or more poloxamers comprise poloxamer 407 and poloxamer 188. The method may also include combining one or more active drugs selected from an analgesics, local anesthetics, NSAIDS, antidepressants, anticonvulsants, opioids, NMDA receptor antagonists, muscle relaxants, or combination thereof.

The topical compositions comprising a topical pain suspension, cream, gel, lotion, ointment, or emulsion described herein may comprise a water content of about 5% or more. For example, the water content may be between about 5% and about 80%, about 5% and about 70%, about 5% and about 65%, about 5% and about 50%, about 5% and about 25%, about 5% and about 15%, about 10% and about 80%, about 10% and about 60%, about 10% and about 45%, about 10% and about 25%, about 10% and about 15%, about 20% and about 80%, about 20% and about 60%, about 20% and about 45%, about 20% and about 25%, about 30% and about 80%, about 30% and about 60%, about 30% and about 45%, about 40% and about 80%, about 40% and about 60%, about 40% and about 50%, about 50% and about 80%, about 50% and about 70%, about 50% and about 60%, about 60% and about 80%, about 60% and about 70%, about 70% and about 80%, about 8% or greater, about 10% or greater, about 15% or greater, about 20% or greater, about 25% or greater, about 30% or greater, about 35% or greater, about 45% or greater, about 55% or greater, about 65% or greater, about 75% or greater, about 80%. In one embodiment, the water content may be about 80% or greater. In another embodiment, the water content may be less than 5%.

The topical composition may be topically applied for treatment of an ailment, e.g., by topically contacting the composition to skin or mucosal surfaces such as by spreading or layering there along. In one example, an occlusive dressing may be applied. The topical composition or derivative thereof may be topically applied to a body surface utilizing for example, spray, drops, atomizer, wash, swab, sponge, absorbent dressing, instillation or irrigation. An occlusive material may also be used in some embodiments, Topical application may be with respect to body surfaces such as trunk, limbs, hands, feet, neck, head, cavities, etc. In various embodiments, the topical composition may find orthopedic application, e.g., as part of a therapeutic treatment of rheumatoid arthritis/osteoarthritis, lateral epicondylitis (tennis elbow), medial epicondylitis (golfer's elbow), chondromalacia patellae—CMP (runner's knee), or tendonitis/carpel tunnel; rheumatologic application, e.g., as part of a therapeutic treatment of soft tissue pain, fibromyalgia, diabetic neuropathy, peripheral neuropathy, rheumatoid arthritis, or osteoarthritis; neurologic application, e.g., as part of a therapeutic treatment diabetic neuropathy, peripheral neuropathy, fibromyalgia, or localized pain; podiatric application, e.g., as part of a therapeutic treatment of diabetic neuropathy, peripheral neuropathy, plantar fasciitis, Achilles tendonitis, tarsal tunnel—post-op massage, or heel pain—which may include usage in conjunction with urea; pain management application, e.g., as part of a therapeutic treatment of soft tissue pain, fibromyalgia, diabetic/peripheral neuropathy, rheumatoid arthritis, osteoarthritis, or neck and back pain; or ear nose and throat or dental applications, e.g., as part of a therapeutic treatment of temporomandibular joint disorder (TMJD or TMJ), or trigeminal neuralgia.

The present disclosure may be embodied in other forms without departing from the spirit or essential attributes thereof and, accordingly, reference should be had to the following claims rather than the foregoing specification as indicating the scope of the invention. Further, the illustrations of arrangements described herein are intended to provide a general understanding of the various embodiments, and they are not intended to serve as a complete description. Many other arrangements will be apparent to those of skill in the art upon reviewing the above description. Other arrangements may be utilized and derived therefrom, such that logical substitutions and changes may be made without departing from the scope of this disclosure.

This disclosure is intended to cover any and all adaptations or variations of various embodiments and arrangements of the invention. Combinations of the above arrangements, and other arrangements not specifically described herein, will be apparent to those of skill in the art upon reviewing the above description. Therefore, it is intended that the disclosure not be limited to the particular preferred arrangements disclosed for carrying out this invention, but that the invention will include all embodiments and arrangements falling within the scope of the appended claims.

Various elements described herein have been described as alternatives or alternative combinations, e.g., in a lists of selectable actives, ingredients, or compositions. It is to be appreciated that embodiments may include one, more, or all of any such elements. Thus, this description includes embodiments of all such elements independently and embodiments including such elements in all combinations.

The grammatical articles “one”, “a”, “an”, and “the”, as used in this specification, are intended to include “at least one” or “one or more”, unless otherwise indicated. Thus, the articles are used in this specification to refer to one or more than one (i.e., to “at least one”) of the grammatical objects of the article. By way of example, “a component” means one or more components, and thus, possibly, more than one component is contemplated and may be employed or used in an application of the described embodiments. Further, the use of a singular noun includes the plural, and the use of a plural noun includes the singular, unless the context of the usage requires otherwise. Additionally, the grammatical conjunctions “and” and “or” are used herein according to accepted usage. By way of example, “x and y” refers to “x” and “y”. On the other hand, “x or y” refers to “x”, “y”, or both “x” and “y”, whereas “either x or y” refers to exclusivity.

Any numerical range recited herein includes all values and ranges from the lower value to the upper value. For example, if a range is stated as 1 to 50, it is intended that values such as 2 to 40, 10 to 30, 1 to 3, or 2, 25, 39 and the like, are expressly enumerated in this specification. These are only examples of what is specifically intended, and all possible combinations of numerical values and ranges between and including the lowest value and the highest value enumerated are to be considered to be expressly stated in this application. Numbers modified by the term “approximately” or “about” are intended to include+/−10% of the number modified. 

What is claimed is:
 1. A method of formulating a topical composition for administration to a skin surface, the method comprising: formulating a topical cream comprising combining: synthetic cannabidiol powder; diclofenac sodium; lidocaine; and prilocaine, wherein the topical cream comprises between about 1% and about 2% diclofenac sodium, between about 2% and about 3% lidocaine, and between about 2.0% and about 3% prilocaine.
 2. The method of claim 1, wherein combining the cannabidiol powder to formulate the topical cream comprises combining between about 10 mg and about 50 mg of the cannabidiol powder into the formulation.
 3. The method of claim 2, wherein combining the cannabidiol powder comprises releasing the cannabidiol powder from a compounded capsule.
 4. The method of claim 2, wherein at least a portion of the cannabidiol powder comprises cannabidiol synthetic powder.
 5. The method of claim 4, wherein the topical cream further comprises between 5% and 20% DMSO. 